Heart failure (HF), the fastest-growing type of cardiac disease in the U.S., is a pathophysiologic state in which the heart fails to pump sufficient blood to meet the needs of the body. In failing ventricular myocytes from animal models and human patients, we and others have demonstrated disruption of the widely distributed and highly organized cardiomyocyte traverse (T)-tubule system. These orderly invaginations of surface membrane into the cell interior are critical for rapid electric excitation, initiation and synchronus triggering of sarcoplasmic reticulum (SR) Ca2+ release, and, therefore, coordinated contraction of each contractile unit throughout the entire myocyte. T-tubule loss and disorganization instigate development of HF due to aberrant intracellular Ca2+ release and blunted contractile function. However, there is a limited understanding of the molecular mechanisms and pathways that regulate T-tubular integrity or that participate in destructive T-tubule remodeling. Our preliminary data indicate that junctophilin-2 (JP2), a structural protein spanning T-tubules and the SR membrane, is crucial for normal T-tubule organization. Our data in animal models of cardiac stress show that downregulation of the JP2 is associated with T-tubule disorganization and HF development. Furthermore, our preliminary results indicate that JP2 downregulation is driven by activation of the Ca2+- dependent protease, calpain, though the upstream events that result in calpain-mediated degradation of JP2 in HF remain unclear. The goal of this project is to define the mechanisms of JP2 dysregulation and T-tubule remodeling in cardiac disease. We will combine multidisciplinary approaches including in situ confocal imaging, electrophysiology, molecular biology, pathological mouse models and novel transgenic mouse models, to test two specific aims. Aim 1. To define the molecular mechanisms underlying JP2 downregulation in heart failure. Aim 2. To determine if and how recombinant JP2 expression can attenuate stress-induced T-tubule remodeling and protect against HF progression. As HF is the most common cause of hospitalization in patients over 65 and causes an enormous burden on our health care system, new therapeutic approaches for HF are still critically needed. The potential positive impact of these studies is that preventing T-tubule dysfunction may represent a novel mechanism-based approach to improve health care outcomes related to HF. Understanding these molecular mechanisms will provide a novel platform for T-tubule-targeted therapies that prevent HF development and progression.